SOMERSWORTH — A Somersworth clinic is among those health care facilities that unknowingly administered tainted medication at the center of a large-scale fungal meningitis outbreak.The medication, from a distributor in Framingham, Mass., has killed five patients and sickened 35 across six states.PainCare LLC, a Somersworth clinic on Route 108, received medications from New England Compounding Pharmacy in Framingham. That company has recently issued recalls and shut down operations since the outbreak was first discovered about two weeks ago in Tennessee. The Somersworth clinic reportedly treated patients with the medication before pulling it from shelves and informing patients upon learning of potential health risks.The type of meningitis involved is not contagious like most common forms. It is believed to be caused by a fungus often found in leaf mold, which health officials suspect may have been in the steroid medication. To date, all those affected received steroid injections, mostly for back pain.While no cases of the illness have been reported in New Hampshire, the situation is being carefully analyzed as the outbreak evolves. “We are not aware of any cases in New Hampshire related to the outbreak at this time,” New Hampshire's Public Health Director Jose Montero stated in a press release Thursday. “We are also conducting surveillance to identify people who might be affected by this situation.”The recalled medication was also distributed to a Merrimack-area PainCare clinic. Montero stated roughly 186 patients are estimated to have received the medication in N.H. Both PainCare clinics, unknowingly distributed the potentially-tainted medication to patients and have since pulled the product and are fully cooperating with ongoing investigations.“We are doing absolutely everything at the moment to comply with the Centers for Disease Control's tight guidelines,” said Michael O'Connell, owner and CEO of PainCare LLC. “As of yet, all our diligence has been precautionary only.”As O'Connell outlined Thursday, all of PainCare's patients exposed to the medication will be contacted and informed of possible symptoms. Patients experiencing symptoms associated with the recent outbreak are asked to seek further medical assistance. Meningitis is an inflammation of the lining of the brain and spinal cord. Symptoms include severe headaches, nausea, dizziness, and fever. Some patients sickened in the recent outbreak also experienced slurred speech and difficulty walking and urinating.Investigators have also been looking into the antiseptic and anesthetic used during the injections. Although neither has been ruled out, the primary suspicion centers on the steroid medication.The 35 cases include 25 people in Tennessee, three in Virginia, two in Florida, Maryland, and Indiana, and one in North Carolina. Of the deaths reported thus far, three were in Tennessee, one was in Virginia, and one was in Maryland, according to the Centers for Disease Control and Prevention.The medication in question was shipped to 23 states: California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, Nevada, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Texas and West Virginia.“We're working to set up a wider safety net to make sure nothing else is missed here in N.H.,” Montero said. “There's a lot of information coming in at the national level. This is a situation that could keep changing very quickly.”